Exploring the associations of unfinished nursing care with individual, team climate, and organizational factors in nursing homes: An observational study

Abstract

<h3>Background</h3><p>Care workers in nursing homes globally report failing to comprehensively provide essential nursing care. This phenomenon of unfinished nursing care has adverse impacts on residents. Inadequate staffing levels are associated with unfinished nursing care, but this alone does not explain its prevalence. Unfinished nursing care emerges in a complex reality, requiring knowledge of its associations with care workers' individual factors, team climate, and organizational factors. These associations have mainly been studied in acute care settings.</p><h3>Objective</h3><p>To explore associations between individual, team climate, and organizational factors and unfinished nursing care in nursing homes.</p><h3>Design</h3><p>An observational study utilizing two cross-sectional data sources.</p><h3>Setting(s)</h3><p>Eighteen publicly owned nursing homes with 122 units in Finland.</p><h3>Participants</h3><p>Care workers (n = 503) delivering nursing care in these nursing home units.</p><h3>Methods</h3><p>Data were obtained from two different datasets drawn from the same nursing home units. The first dataset consisted of results at the nursing home unit level from the national Finnish Public Sector (FPS) study. The second dataset consisted of questionnaire responses from care workers related to unfinished nursing care. Multiple linear regression analysis examined the associations.</p><h3>Results</h3><p>Non-nursing tasks were statistically significantly associated with increased unfinished nursing care in all four care types: activities of daily living (β = 0.186, 95 % CI 0.071–0.302), caring, rehabilitation and monitoring (β = 0.260, 95 % CI 0.155–0.366), documentation (β = 0.376, 95 % CI 0.221–0.530) and social care (β = 0.487, 95 % CI 0.301–0.673). Better work-related well-being (β = − 0.123, 95 % CI − 0.233 to − 0.012) was associated with decreased unfinished nursing care in social care. Temporary employment contracts were associated with decreased unfinished nursing care in caring, rehabilitation and monitoring (β = − 0.193, 95 % CI − 0.366 to − 0.020) and social care (β = − 0.357, 95 % CI − 0.720 to − 0.042). No clinically significant associations were found between unfinished nursing care and team climate factors.</p><h3>Conclusions</h3><p>The identified associations with unfinished nursing care in nursing homes highlight this complex issue, but the exact mechanisms remain unknown and require further investigation. Future studies should focus on nursing leadership and decision-making processes to better understand the underlying mechanisms potentially explaining unfinished nursing care.</p>